Bill
102 – Changes to the Drug
Interchangeability
and Dispensing Fee Act
& the Ontario
Drug Benefit Act
[The
following article was originally published in HALCO News, the
newsletter of the HIV & AIDS legal clinic (Ontario), a specialty
legal clinic in Toronto. Reprinted with permission.]
Bill
102 is the Ontario government’s response to escalating costs for
drugs, and complaints about the programs we have to help people
access drugs.
The
Bill, if passed, would make changes to the Drug
Interchangeability and Dispensing Fee Act
(DIDFA) and the Ontario
Drug Benefit Act
(ODBA).
Some of the key changes are:
- A
new “Conditional Listing” category will be created for new drugs
that have not yet been fully evaluated or processed for formal
listing. This will allow patients to access new drugs on a
conditional basis without needing to go through individual section 8
applications.
- A
position of “Executive Officer of the Ontario Drug Programs”
would be created. The Executive Officer would be a political
appointee who would exercise many powers now held by cabinet and the
Minister. These include placing drugs on the ODBA formulary (the
list of drugs funded for ODSP, OW, Trillium and seniors), removing
drugs from the formulary, deciding who will get unlisted drugs
(those not listed on the formulary) in special circumstances (the
current ODBA Section 8), and designating which drugs are
interchangeable.
This
could potentially result in decisions being made more quickly. For
example, new drugs could be made accessible more quickly and
decisions on funding unlisted drugs could be made more quickly.
However, there could be questions about the accountability of the
Executive Officer – a great deal of authority would be placed in
the hands of one unelected official.
- The
criteria for designating drugs to be interchangeable would be
loosened. Currently a pharmacist can dispense a generic drug in
place of a name brand drug prescribed by a physician. However, this
can only be done if the actual drug and the formulation are the
same. Under the new Act, interchangeability would be broadened.
For instance the Executive Officer could designate a product to be
interchangeable if it contains “the same amounts of the same or
similar
active ingredients in the same or
similar
dosage form.” This is intended to lower the cost of drug
treatments by allowing more generic drugs to be dispensed. However,
this also has the potential to result in serious medical problems
when a pharmacist dispenses a drug or formulation different than
what the doctor prescribes.
- Rebates
from drug companies to pharmacists will no longer be permitted.
Currently, drug producers can give rebates to pharmacies that
dispensed their products. This is an incentive for pharmacists to
dispense generic drugs which are interchangeable with name brand
drugs. This is, again, intended to reduce the cost of drugs funded
under the ODBA. Some pharmacists have argued that small independent
pharmacies depend on these rebates to stay in business and that
without this source of income some pharmacies would close. Although
not part of Bill 102, the government has also announced that the
mark-up pharmacists can charge on a product will be reduced from 10%
to 8 % and capped at $25. This could make it impractical for small
independent pharmacists to stock expensive drugs (e.g.
anti-retrovirals), again making these drugs less accessible.
- The
current ODBA Section 8, under which unlisted drugs are funded in
special circumstances, is replaced by Section 16. The wording of
Section 16 is almost identical to Section 8 except that the
Executive Officer will now make decisions under the section in place
of the Minister who currently has the authority to make these
decisions. Also, the new Section 16 states explicitly that
decisions made under the section can be made to apply retroactively.
This is not included in the current Section 8.
Although
not part of Bill 102, the government has announced that the current
Drug Quality and Therapeutics Committee will be renamed the
“Committee to Evaluate Drugs” and will include 2 patient
representatives. This committee would be involved in individual drug
funding decisions. The creation of a Citizens’ Council, which
would provide recommendations on related policy issues, has also been
announced.
Bill
102 has been referred to the Standing Committee on Social Policy and
public hearings have been scheduled for May 29 and 30 and June 3, 4
and 5. HALCO will continue to monitor developments in this area.
